Provider Network Director jobs in Ellicott City, MD

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Directs the compliance program for the UMMS Physician Network (UMPN), Ambulatory Care, and Urgent Centers.
2. Collaborating with the CCBEG Education Department for the development and delivery of a training program, establishing a culture of compliance and coaching on program features such as ethics, fraud, gifts, entertainment, etc.
3. Assists the Physician Network, Ambulatory Care, and Urgent Center leaders in conducting compliance risk assessments of the billing, coding, operations, and the implementation of annual work plans to ensure that identified risks are appropriately mitigated.
4. Occasional travel to sites to conduct training, liaise with business leaders, and ensure correct application of compliance program.
5. Establish and maintain a strong working relationship with stakeholders at all levels of the UMMS hierarchy.
6. Prepare oral and written reports, including recommendations for improvement based on audit and investigative findings.
7. Maintain an awareness of current laws, statutes, regulations, etc., that impact healthcare operations and physician relationships.
8. Initiates, coordinates, develops, implements, and disseminates policies, procedures, and standards for the physician network, ambulatory care, and urgent care centers.
9. Attends and presents to assigned committees, e.g., Town Hall and other UMMS Compliance-related meetings, as requested.
10. Chairs the quarterly University of Maryland Physician Network (UMPN) Compliance Committee.
11. Collaborates with various State and Federal Regulators such as OCR, HHS, OIG, CMS, and MHCC on pertinent compliance-related matters.
12. Assists with developing compliance-related orientation for physicians (initial and ongoing).
13. Develops and maintains a newsletter for the physician network.
14. Communicates to the VP of Hospital and Physician Compliance on any matter that potentially requires external reporting or is deemed potentially illegal, unethical, or otherwise inappropriate.
15. Maintains current knowledge of physician-related coding and billing guidelines, regulations and national trends pertaining to Center for Medicare and Medicaid Services (CMS) and Department of Health and Human Services (HHS) requirements as they relate to compliance operations.
16. Consults with internal counsel as needed to resolve difficult/legal compliance matters.
17. Supervises and manages direct reports.
18. Obtains up-to-date information on changes to rules, regulations, and other agencies’ guidance and initiatives.
19. Develop productivity benchmarks for Physician Network, Ambulatory Care, and Urgent Center compliance staff.
20. Implement performance improvement strategies to ensure performance metrics for accountability are consistently met.
21. Responsible for organizing and managing the daily operations including workflow, staffing, data management, and reporting. Develop systems and processes to organize daily review, investigation, and closing of cases.
22. Perform other duties as assigned.

The University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team. 

• Bachelor’s degree required.  Master’s degree preferred; JD Preferred.
• Five (5) years of related compliance experience with a background in healthcare regulatory issues, including general familiarity with physician coding and billing, is required. Four (4) years of experience in healthcare or regulatory fields is preferred.
• Certified in Healthcare Compliance or other professional compliance certification preferred.

All your information will be kept confidential according to EEO guidelines.